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Scottish Care Open Webinar – 30 April

The latest Covid-19 webinar will take place on Thursday 30 April at 3:30 pm with our CEO, Dr Donald Macaskill and National Director, Karen Hedge.

Please note that this webinar is open to external colleagues and Scottish Care members. Therefore you will need to register for approval before you can attend this webinar. Once your registration has been approved, you will receive an email with a unique URL link to join the webinar.

You can register for access here: https://us02web.zoom.us/webinar/register/WN_GPdb-KDPRcyObTdyGu4Wqw

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New nursing blog – ‘With change comes new beginnings’

With Change Comes New Beginnings…

As the National Transforming Workforce Lead For Nursing my aspiration for 2020 was looking forward to a year of celebrating nursing, in this ‘The International Year of the Nurse and Midwife.’ Nursing was finally being given a platform to showcase the profession, as nurses in the main are not known for blowing their own trumpets -being a nurse is simply what they do. However, we find ourselves celebrating the invaluable work nurses have done, and continue to do, as a direct result of the new reality we are living in.

Historically nurse leadership has been core to ensuring progress, quality care and recognition for nursing achievements and this was highlighted in my March nursing blog around inspirational leaders, which is hard believe was only last month.

Over recent years the nursing profession has however shown signs of erosion, with a decline in nurse applicants across the country, particularly in the school leaver age group and an increase in experienced staff leaving in advance of their retirement date, and in some sectors leaving in advance of the early retirement date. There was recognition that both the NHS and social care sector were facing increasing pressures on services, compounded by a significant number of vacancies across medical, nursing and allied health professionals and social care staff, resulting in critical concerns around recruitment, retention and sustainability.  The reduction in university applications in nurse training in some rural areas had also resulted to some degree of sustainability issues for pre and post registration education.

There was therefore a concerted effort and desire to transform roles to manage our changing demographics. The formation of Health and Social Care Partnerships (HSCP) ideally were to address this and support our frontline workforce. Transformational programmes were being adopted across all sectors to ensure the future sustainability of the workforce, from changes to nurse education to primary and secondary care restructures. Working across different professions and sectors to achieve this had resulted in slow progress for true integration, as there was limited alignment of budgets, competing agendas and a significant lack of understanding of the pressures staff were under, which has led to demotivation and low morale, with staff leaving as a result of this.

Burnout had reached an all-time high. This was highlighted within a number of reports and surveys since the inception of integration in 2015. According to the Royal College of Nursing (RCN) Employment Survey in 2019, pressures have increased year on year. A high majority of nurses were feeling continuously under pressure, with ninety per cent saying that they frequently worked through their breaks and sixty-three per cent saying that they were too busy to provide the level of care they would like.  Most concerning was that seventy-nine per cent of nursing staff felt that staffing levels at their place of work were insufficient to meet patient needs and seventy-seven per cent felt that patient care was compromised throughout the month due to short-staffing. Nurses had become fearful of losing their registrations and in light of this the Nursing and Midwifery Council (NMC) had finally recognised the need for a support phone line to prevent further distress and mental health issues within nurses.

The year started in a state of crisis, however there was also a real sense of hope and positivity  that we could improve the global recruitment and retention of frontline staff under the light of the International Year of the Nurse and Midwife .We had a prime opportunity to show the public, alongside existing and future staff the good work being done in our NHS hospitals,  but as importantly our communities, especially our care homes, who were providing quality care in a homely setting to an increasing number of people with significant health issues. These were physical and psychological, with dementia and frailty now being the key reasons for admission.

Little consideration had previously been given to social care nursing, often thought of as the Cinderella Service, with nurses and carers often viewed as less academically qualified, lacking leadership skills and not providing specialist care. There is no doubt nurses who work within the sector have high levels of compassion and empathy but alongside this have high levels of leadership, autonomy and expertise, and possess professional academic achievements which would challenge any specialism. Despite the desire not to promote care homes as clinical areas, this has no reflection on the quality of clinical care provided within a holistic ethos.

Then came something that would test everything, a coronavirus pandemic.

The last 6 weeks have without question witnessed the greatest level of transformation that health and social care has ever seen. No longer was there time to debate or mull over ideas or options but instead there needed to be a national pulling-together to manage a crisis that had the potential to cause destruction on a level never seen before in our lifetimes. Nursing had responded to many events in history, however at no point in time would our services and ability to care be challenged to this degree.

Sadly, the downside would be that lives would be lost on a global scale and it was imperative that those dependent on our services would have access to the appropriate care and be given the necessary dignity and respect at this time, underpinned by safe practice, compassion and honesty. Nursing was now under the microscope and being catapulted into a new world which required immediate action.

To prevent further decline in our nursing workforce an emergency recruitment campaign aimed at those staff who had left the register in the last 3 years to return during this crisis resulted in approximately 8000 nurses and midwives rejoining the register. This has most recently been further extended to staff who have left up to 5 years ago, which accounts for approximately another 40,000 staff and around a further 1,800 overseas staff. Included in this was the redeployment of staff to the key areas as well as emergency recruitment of nursing students in their final 6 months of training and subsequently 2nd year students also, who both had the choice to opt in or out. This was a request that has caused a lot of deliberation for qualified staff, as well as students. This level of change, alongside delays in information around use and access to PPE, testing and shielding of staff has resulted in our nurses and carers working within extreme physical and psychological situations , further stretching staff who had already been working above and beyond.  NHS was rightly the initial priority area for staff redeployment, however due to matching staff skills we now have staff and students placed within our care homes, which has been welcomed and hopefully strengthens our existing workforce.

The degree of media coverage has been welcomed but needs to remain balanced. However, this has finally positively highlighted that our care home staff are key frontline staff, covering the determination, devotion, knowledge and skills of our social care workforce against the sad reality of the impact to the sector. We are seeing a move to more community integration and resilience, with clinical in-reach to our care homes supported by our hard working ,often under recognised community nursing teams, who have been instrumental in being the conduit between NHS, HSCP’s and social care.

As this virus predominantly attacks people over the age of 75 years it is unavoidable that we continue to see this demand and incidence within social care and within our communities during lockdown. Nurses and carers have been there from the beginning trying to manage the care of their residents with empathy and ensure advocacy for all those under their care, at all times. With this has come great frustration and impact on the health and wellbeing of residents and their family due to being isolated throughout lockdown. Staff have been left feeling helpless and unprepared at times to deal with their own emotional and psychological issues due to the loss they have witness and the need to continue to provide quality care, whilst struggling themselves.

Our care sector has sadly seen a continual increase in residents losing their lives to covid-19 and in some areas experiencing cluster outbreaks, this has had a significant impact on wellbeing. Care home staff provide an excellent level of care and especially in relation to palliative and end of life care, after all it is the last thing we can do for our residents.

In recognition of this nurses have united to ensure the people within our communities receive the optimum care during this time and are utilising every guidance and resource available in relation to infection control, palliation and also around wellbeing and mental health for staff and residents alike. This has become increasingly important during this pandemic due to the reduced contact with families and decisions that have had to be made to protect people. One of most distressing elements of this reality is some families have not been able to be there when their relative was dying. This has been due to the protective restrictions which were necessary over the last few weeks. However, the humanity shown by our nurses and carers has been a welcomed comfort to families, to know their loved ones have not died alone. As guidance and knowledge around infection control and use of PPE improves this will hopefully not prevent any other families from being together with their loved one at the end of life.

The facts are that despite the unbelievable pressures put upon our staff they continue to come to work each day, do overtime, with some staying within the care homes to minimise risk. This has resulted in positive realisation of the work our staff do, despite minimum wage, they do the job cause they genuinely care, the key requirement of anyone wanting a career in care. Unfortunately, some staff have also lost their lives across the country, with some of these being staff who had returned to practice to help. In addition, many staff have had to deal with the loss of colleagues and residents, who were, for all intents and purposes their care home family.

In this week of compassionate communities think about how people respond to crisis, how we need to support people to continue and most importantly how we never go back to not recognising what our nurses and carers give every day.

We can’t go back, we must continue to progress and keep and build on the relationships that have been formed over this short period when the world has achieved phenomenal feats.

If we can build temporary hospital in a few days surely we can build a sustainable workforce, value the contribution  and sacrifices our staff make daily and make nursing a career to strive for, after all its what we do that matters ……

According to Louis L’armour ‘there will come a time you will believe everything is finished; that will be the beginning’.

We look forward to a ‘new normal’ that means there is no shortage of nurses and everyone can access care provided by the right person, at the right place, at the right time.

Jacqui Neil

Transforming Workforce Lead for Nursing

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Scottish Care calls for significant escalation in care home testing

There is international recognition that care homes are particularly vulnerable to the threat of Coronavirus. Sadly, the international statistics show that between 42 and 52% of all fatalities are likely to have been individuals who have been care home residents.

This makes it imperative that we have a clear strategy to reduce the threat and address the risks which Covid-19 poses for our care home population. Therefore, in light of international clinical evidence and measures announced in both Northern Ireland and England, Scottish Care is today calling for the following:

1. When a Covid-19 case is diagnosed in any care home that all residents and staff are immediately tested. This would enable appropriate action to be taken on isolation and nursing for residents and for staff to self-isolate. This will inevitably require additional staffing support for those care homes which are most affected.

2. All staff in care homes and providing care at home regardless of direct care roles should wear face masks in order to reduce the transmission of the virus. If it is appropriate for face protection to be worn when citizens go shopping then within a care facility it seems equally important that face masks are worn when not in direct contact and that adequate face masks are worn within a two-metre distance. We recognise that for services which do not normally wear such masks this will be a massive increase in demand for PPE. It will be necessary for these increased costs to be addressed as a matter of urgency or care providers risk going out of business during this pandemic.

3. That steps are put in place to develop a strategy whereby staff and residents in those care homes which have thus far have had no cases are fully tested.

We recognise that tests can be distressing for individuals living with dementia but those care staff who know them well will help to provide comfort and reassurance at a time when such steps are critical in the challenge which Coronavirus is posing to those accessing care and support and those working in the sector.

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Care home complaints guide

The Chartered Trading Standards Institute (CTSI) has launched a new complaints guidebook for the UK care homes industry.

The guide itself and the supporting documents are available on their business companion website along with a youtube link to the video they have commissioned to support the guide.  These can be viewed here: https://www.businesscompanion.info/focus/care-homes-complaints

Care home complaints infographic
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Letter from Cabinet Secretary and COSLA: Minute’s silence on International Workers’ Day

Please see below for joint letter from the Cabinet Secretary for Health and Sport, Ms Jeane Freeman and the COSLA Spokesperson for Health and Social Care, Cllr Stuart Currie. The letter asks that wherever possible, for colleagues to participate in a minute’s silence at 11 am tomorrow (28 April), on International Workers’ Day in honour of our colleagues who have sadly lost their lives to Covid-19.

20 04 27 IWD - joint letter Cab Sec and Cllr Currie
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The ‘new care normal’

The new care normal

The First Minister published the Scottish Government’s strategy for coming out of lockdown on Thursday and encouraged a public debate on the issues which the document raised.

For the social care sector coming out of lockdown is likely to be very challenging. If as it is envisaged that there will be a phased and incremental removal of restrictions it is highly likely that this will mean that formal care settings will be amongst the last to be back to familiar patterns of behaviour and access. Even when this happens it is likely that social distancing will continue for some time and that staff will be required to continue to utilise a high level of PPE. It is likely that there will need to be increased staffing levels in a sector which has most recently been faced with acute staffing pressures and significant economic instability. But over all these very important and genuine concerns there should be a heightened awareness of the impact on those who are the recipients of social care and support.

Over the last two weeks in particular it has become clear that the levels of distress, of emotional and psychological harm, upon those living with dementia in our care homes and in our communities in Scotland are becoming more and more acute and worrying.

The ongoing focus in care homes in particular has been quite rightly the sustaining of life. This has led to the development of guidance which has meant that for 6 weeks our care homes have been in effective lockdown with only rare visits at the end of life and in the earliest couple of weeks for one named individual per family in situations of real distress. I fully understand and appreciate that concomitant to this have been clinical and infection control measures which have advocated self-isolation and social distancing; the end to the use of communal spaces and effectively the confinement of individuals who have been symptomatic.

Such ‘emergency’ measures have been justified as necessary and proportionate in order to achieve the legitimate aim of the maintaining of life. But I now believe that six weeks on we need to consider and actively debate both how long these restrictive measures can continue but also whether they are indeed the most proportionate and human rights-based interventions.

My personal concern is that we need to get a better balance between proportionate restriction of freedom of movement in order to attain infection control and a diminishing of normal life to the extent to which it is causing psychological and physiological damage e.g. through increased falls, impact on nutrition, effect on hydration, increases in delirium state etc. I am concerned that too many assumptions have been made in the adoption of infection control practices which fit an acute hospital-based environment without a full  appreciation of the nature of care homes and of the population that is supported within them. I am fully aware that there is growing epidemiological evidence around the nature and rate of transmission of Covid-19 in care homes and that we are some distance from the peak of the challenge. However, we have to more fully recognise specifically that the levels of acuity in care homes are exceptionally high and in particular that the vast majority – probably about 90% – of residents have some form or another of dementia.

Lockdown from the perspective of someone living with dementia has been in many instances quite frankly, simply hellish. Staff have spent a lot of time reassuring, being present, reminding and reaffirming what individuals about what is happening. They have supported people to understand why family have not visited and have used technology to help people to remain in contact. But sadly, such measures have only worked for a minority. For many more this has been a maze of confusion, distress and very real emotional trauma. The familiarities of touch, eye contact, physicality and presence have been denied them. The rhythms of routine so fundamental to someone living with dementia have been replaced by strictures and detachment which is causing real harm. Despite all the best efforts of nursing and care staff, care homes even where there have not been cases have changed.

Outside in the communities we are hearing equally distressing stories of individuals without family support who are immensely confused and disturbed by the changes in the pattern of their encounters with homecare staff, with neighbours and with friends.

I am convinced that we need urgently, not just as a care sector but as a whole society, to think about how we are going to support the ‘new care normal’ in care homes and in communities.

If we are to continue with some form of restricted access for some time then we need to appreciate that a care home is not an institution or a unit – it is someone’s home – and we need to get back to that understanding as quickly as possible. We need to re-connect care homes to families and vice-versa taking appropriate precaution but balancing risk against the reality that for many individuals their lives are greatly diminished and risk being fore-shortened by current measures. We need to create a real army of volunteers and others prepared to support the added demands of staffing which will be necessary with new models of care which need to maintain their human touch and person-led focus. Critically we need to urgently move from self-isolation to safe social distancing within the confines of the physical environment of a care home supporting re-connection and re-membering.

Within the wider community I am also concerned that some of the narrative which we are hearing in the media is presumptively assuming that there will be the use of age restrictions in our exit from lockdown, so for instance those over-70 may be in lockdown for a longer period of time. Just as withdrawing treatment based upon age was unacceptable as an ethical choice so I would contend such restrictions would be equally unacceptable. Setting different rules based on age is a blatant form of discrimination. It is one thing to seek to shield those most at risk because of underlying health conditions it is quite another to use blanket catch-all prohibitions.

The ‘new care normal’ needs to be molded by families and residents, citizens and carers, clinicians and professionals, so that together we get the right balance between risk and life. We urgently need to have this care conversation as part of the national conversation the First Minister started on Thursday. Put simply there is a difference between existence and living and for many living with dementia at the present time that balance seems not quite right.

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The journey thus far – blog from Verity Monaghan

The Journey Thus Far

The last two months have been a tumultuous time due to the outbreak of COVID-19 which has sent shock waves through the world and has had devastating effects on families and services and restricted the lives of many . However, on a more positive note it has also been a time for deep reflection and re-connection of what is truly important and to look at how we can be more creative in our approach to meet our human rights and needs.

Moreover, for those who do not know, this is my final week before I go off on maternity leave and so it feels like the right time to reflect on the fantastic progress of the Rights Made Real project during phase one of the programme and take a look at what the future of the project holds. Lastly I felt that this was a prime opportunity to look at human rights in light of the current climate and how the projects have used what they have learned during this project to not only maintain the safety of themselves and residents but also how they have used their skills, learning and knowledge in a creative way and continue to make rights real in spite of the ongoing crisis.

Phase one – making rights real

The first phase of the Rights Made Real in Care Homes Programme was funded in 2018 for 2 years and is due to finish at the end of July 2020. Moving forward, I am delighted to announce that there will be a phase two extension to the innovative rights-based work that has been happening to improve the lives of those with dementia living in a care home setting. Further information will be released soon about what this will look like in the coming months – so keep your eyes peeled.

The aim of the project overall, has been to demonstrate and embed a rights-based approach to dementia care and each of the seven groups of care homes have taken unique and innovative approaches in how they have achieved this. You can find more information on what each of the projects were involved in here. https://scottishcare.org/about-rightsmadereal/

There has been an abundance of learning as a result of the project so far. Tamsin MacBride from UWS has been pivotal in the role of collecting, connecting and evaluating this learning from the different care home sites using My Home Life, appreciative inquiry and action learning approaches. This learning was compounded in the “Away Days” in October where we brought the projects together for two days of reflection and future forming workshops and key speakers involved in human rights in the health and social care sector. This time of reflection has been invaluable in maintaining the momentum, readjusting the focus of the projects and reinvigorating the motivation to look at human rights in new ways.

One of the key quotes from those Away Days was the realisation that,

“Many paths can lead to the same destination.”

Some of the other general learning from the Away Days was around:

  • developing confidence around using human rights language
  • communication with staff and residents around what is important to them and how to meet needs in a rights based way.
  • addressing fears when it comes to human rights
  • translating human rights into practice and how to take the next step of moving from rights aware practice to rights based practice.

Phase two and human rights resource – a journey of discovery

Phase two of the project will seek to consolidate the learning from phase one and explore how this can be used to influence other care homes across Scotland. As the project comes to the end of phase one, there is a strong sense that the care homes have more they would like to learn. Phase two will go deeper than being rights aware to embed rights based approaches into practice.

So with that in mind, my role when working with the projects in 2020 has been to co-create a human rights resource with the projects to document the journey of discovery of the learning throughout the different organisations. There has been a clear transfer of learning throughout individual organisations, so we felt it was beneficial to share the journey in order to showcase how human rights are met through different tools and approaches. This resource will be available in the early Summer so please look out for more information on this.

 

Human rights – what do they look like in the face of a global pandemic?

From the beginning of 2020 as a result of the global pandemic, the world’s citizens have had their human rights inside and outside their home restricted and limited on many levels in order to protect public health and care homes are no exception. This project has highlighted how important and intrinsic the enjoyment of our human rights are in our everyday interactions and lives and this global pandemic is an example of how our fundamental human rights can be restricted in order to protect public health. It is useful to be able to understand what our human rights are and the principles of human rights so that decisions are being made proportionately, necessarily, and legally to protect people.

There have been many effects of restrictions specifically, with regards to social distancing for those with dementia in a care home. This has meant that a restriction to Article 5: The right to liberty has been applied. This can have a detrimental effect on someone with dementia who may not understand why they are not allowed to travel outside or to meet up with family or other residents and it is imperative that all decisions should be made to ensure the least restrictive option. Scottish Care CEO Donald has written a thorough and thought provoking article on the ethical choices that are having to be made as a result of COVID-19 – https://scottishcare.org/the-hardness-of-covid-ethical-choice/

All of Article 8 which is around the Right to private, family life and correspondence have been affected. This includes psychological integrity (mental and physical well-being), the development of ordinary family relationships and the enjoyment of current home all of which are affected through social distancing and the measures that the government have put into place. These restrictions have been especially difficult to navigate for those at the end of their life and those who have had to make the decision to attend hospital for life saving treatment.

However, as daunting as these measures sound, there are many examples of health and social care organisations taking steps to ensure the least restrictive option in a creative manner. This includes family visits from outside the care home and using Skype and FaceTime to connect with loved ones. Also, there has been an uptake of social activities electronically and connecting via technology. Scottish Care has also set up a technology device network where organisations and individuals can donate devices so that residents can maintain connection with their loved ones – https://scottishcare.org/techdevicenetwork/

It has been so encouraging to hear from the project leads that their time involved in the project has prepared them with the skills, knowledge and tools to be able to navigate this crisis using human rights, including buiding confidence in:

  • Balancing safety with maintaining connections with family and friends – using social media and technology to connect families when they cannot be together physically.
  • End of life care – ensuring the maintaining of connections at the end of a resident’s life.
  • Being able to challenge decisions that are not felt to be proportionate.
  • Harnessing creativity with regards to activities within the care homes.
  • Connecting with the local community – care homes are being supported by local community businesses through the supply of local produce, food, ice cream, milk etc.
  • Intergenerational work has continued with nursery age children sending in encouraging drawings to connect with residents.

 

My time in this role has sadly temporarily come to an end and therefore I would like to take this opportunity to thank all of the projects for their ongoing dedication and commitment to improving the lives of those they support and for their incredible attitude even in the face of a global pandemic. Last but not least my colleagues at Scottish Care, who have been the continuous voice of the independent social care sector and have been very supportive throughout my time as policy and human rights worker in supporting the vision to make rights real for those in care homes.

 

Stay safe and stay tuned for more updates soon,

 

Verity Monaghan

Policy and Human Rights Project Worker

 

 

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Scottish Care works with local organisations to address PPE shortage

Access to PPE supplies for the social care sector in Scotland has been a major concern for Scottish Care members since the beginning of the Covid-19 pandemic. As the crisis grew, social care PPE supplies that would typically cover a care home or care at home providers needs began to diminish. Trying to get ahead of the curve, our members reached out to suppliers who in many instances were prioritising NHS orders and were unable to supply the social care sector. This meant it was very difficult for care providers to source the significant increase in PPE required to keep residents and staff safe. Social care providers resorted to sourcing their PPE through emergency supplies from NSS and other suppliers. What’s more, our members have been reporting astronomical and unreasonable cost increases for sometimes lower quality PPE items, impacting the financial sustainability of these organisations since these costs are not being reimbursed. This has made it even more difficult for providers to source PPE through their usual routes for their ongoing and ever-expanding needs.

In the midst of this PPE shortage, a large number of independent, smaller organisations, individuals and local communities have reached out to us to offer supplies to Scottish Care members for free or at low cost. Some of the companies have even adapted their normal functions to create products such as hand sanitisers and protective face visors and masks to help frontline workers during this crisis. The team at Scottish Care have been working hard to build partnerships with these people and organisations to ensure that our members are able to access PPE outwith traditional routes. Thus far, we have been in touch with over 100 different organisations, with the details of nearly 30 companies listed on a member facing webpage. It is our hope that this webpage will develop further with more contacts to support even more of our members to access PPE.

Scottish Care appreciate that these individuals and organisations are keeping the social care sector in mind during these unprecedented times. We are extremely thankful for all the time and effort they have put into sourcing or producing PPE. These offers have also been well received by our members, with some suppliers citing that website traffic, orders and enquiries have increased substantially since featuring on our webpage.

Karen Williamson, Director of New Horizons Inc. said:

“We contacted Scottish Care last week with our offer to supply urgently needed face masks to care homes. They informed us that the issue of meeting high minimum order quantities with large suppliers was a major stumbling block for the smaller care homes and asked us if there was anything we could do.

We immediately established a system whereby the smaller care homes could place their orders with us, and we could group them together into one larger order and simply split shipment.

Within 1 hour of our initial call, our contact and product details were live on the member portal and we were taking orders that same day. We are delighted to say that care homes including Rivendell in Birnam and Newlands in Dunfermline received their face masks within 2 days of placing their order.”

Mandi Cooper, Managing Director of National Property Auctions said:

“We are a construction business who are currently helping to support with the PPE demand and the battle against COVID19.

With family working on the front line and family sadly being taken from us from this horrible illness we wanted to help as many people as we could. I saw Dr Donald Macaskill on the news and decided to get in touch. They have been amazing; we were advertised on the website and within hours we have placed orders and helped many care homes with PPE, and we will continue to do so. PPE is very important, and we have contacted the British Embassy in China to check all of the paperwork and certificated to ensure all products we are taking to the frontline are safe, secure and stand the test. This is a huge learning curve for me, and the team and we will keep working hard and learning to help as much as we can. We want to help and support in any way we can, and we are proud to helping supply PPE to frontline workers.”

Lynda Rogers, Manager of Caley Home Care said:

“Due to the shortage of hand sanitiser and with the support and advice from Lynn at Scottish Care, we made contact with a local distillery who were producing hand sanitiser instead of gin.

The Port of Leith distillery, very kindly supplied us with 10 (Gin) bottles of hand sanitiser for free.

Their kindness merited a purchase of some Gin as a thank you gesture. They remain unopened at this time, but I do look at them often fondly

I’m saving it for normality returning!“

 

Pictured: Val Allen (Independent Sector Lead for North & East Ayrshire – Scottish Care) delivering protective face shields to Heather Lundie (Manager – Crossgate Care Home).

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Latest Covid-19 Blog from our Workforce Lead

It has been said that during times of crisis it can bring out the best and worst in us and we have seen a great deal of that in real time with COVID-19. We have witnessed the support for NHS and social care workers on Thursday evenings, the realisation of the commitment these individuals give to their work often to their own personal detriment. We have also seen the judging of others and the way our society seems to place people on a scale of worth, this has been particularly highlighted in the comparison between NHS health staff and social care workers. Not by the staff themselves, I hasten to add, but by the general public, at times the media and by companies including supermarkets who initially deemed social care staff as a lower priority (apart from Sainsburys where I will be shopping from now on).  There has also been at times the feeling that social care is not as deserving of the same level of support and compassionate treatment their health counterparts have received.  This historical lack of value and respect has a profound impact on the social care sector and workforce and can be evidenced in the high level of staff absence that has been generally seen within the sector and which has been rising over the last 5 years.  But is it any wonder that staff who give so much of themselves to care for others experience high levels of burn out and sickness when they are low paid, lack decent work structure and security of work and are treated as an afterthought by most other professionals including those who commission their services and work.

The thing about the social care workforce is that despite this lack of respect, in times of crisis we see them again and again get their heads down and get on with things. You just have to look at Twitter and other social media sites to see the amazing work that is being carried out by care workers within care homes and in communities across the country. This is not new, COVID-19 may be something that thankfully we have never experienced before, however there have been other occasions notably during extreme adverse weather that we have seen these workers, at a time when others are staying safe at home, getting out and battling the elements to provide much needed care to those who are vulnerable.  When it is over it is back to business for the “just a care worker”, gone are the thank you’ s across social media, gone is the focus on the work they do and gone is the brief increase in value and respect.

During COVID-19 we have seen care home staff move in with their residents to ensure that they can limit the possible contact with the infection as much as possible to protect those they care for, this is obviously at a huge personal sacrifice.  Care workers, managers and care home owners have been and are currently away from their own families and homes for weeks while they have prioritised their work and residents. Surely these are the same levels of commitment and values that we see within the NHS and for which we give praise to the doctors and nurses who are working within hospitals. The same call to provide care, compassion, and assistance to those in our society who most need it. I would never try to take away from the amazing work saving lives that doctors and nurses and other practitioners across NHS do daily, it can also be seen time and time again. Doctors and nurses sleeping on floors, exhausted but willing to get up and start all over again. I am asking why this is reserved only for these individuals and why care and support workers and care home nurses are deemed not to be as worthy or deserving the same level of respect? I am also asking that the work of social care be recognised as lifesaving as without the highly skilled level of care they provide, individuals would be unable to stay safely at home and within their communities. Staff who prevent hospital admissions due to their knowledge and understanding of those they care for and their individual health needs, this is also lifesaving work!

Social care providers and the workforce give true person-centred care and that is more than just knowing someone’s likes and dislikes.  It is about understanding that person, knowing about how their health conditions including pain can impact their lives and the challenges that many people face and overcome every day.  We hear about it and see it in the stories that appear particularly right now when families have been unable to be with their loved ones, about the care workers and nurses who sit with people and hold their hands to the very end.  Staff who provide the type of care that often is intuitive, is highly skilled and can be honed through years of experience.  Palliative and end of life care that is given freely but comes at cost to the worker although it is an aspect of their role they find rewarding.   Giving piece of mind and comfort when it is most needed in the last days of a person’s life, how can this work be misinterpreted or not be recognised as being highly skilled and something that certainly most people find extremely challenging to do?

If there is any doubt about the lens that social care and it’s workforce is viewed through it can be clearly evidenced in the recent approach to supplying vital personal protective equipment and the initial lack of staff testing out with the acute sector. We know, despite the denials, that companies providing PPE were instructed to supply to the NHS as a priority to the point that many of our care providers were unable to source their normal day to day requirement of gloves and aprons. We have spoken with many of our Scottish Care members who were struggling to obtain necessary PPE to keep those using services safe and to keep vitally important staff delivering care safe. We also know from these individuals who were experiencing real panic and distress that the majority of their concern was for their service users and residents understanding how vulnerable they are in this current situation. This in itself has been traumatic; managers and owners have done everything within their power to source the needed equipment from paying much higher costs to travelling great distances to obtain PPE when needed. Bearing in mind of course these are the “greedy private providers that do not care about anything but making money” and yes that was sarcasm.

Can you imagine working for an organisation you trust and respect, knowing they invest a great deal in their staff and services. Working with and for people who are committed to long hours managing service delivery and ensuring peoples safety.  Doing a job that you love because of the reward of helping others and then being told you are greedy and only doing this for a profit.  This is while being the lowest paid section of the care sector, the most ignored and the last to receive financial assistance or support in times of need or crisis.  Independent and third sector providers and their workforce are the best of us, they do this extremely hard and challenging work with little support or financial assistance while in a climate of being told they expect too much and are not deserving of the same respect and value others receive.

During COVID-19 social care providers and their networks are constantly being told we are in this together whilst receiving little assistance. Guidance has been issued around support that providers may require due to the current changing nature of care, increasing workload pressures in some areas and decreasing pressures in others as some services have been cancelled due to family being available or because they are shielding. Increased costs surround PPE are a huge factor as prices have soared and there is a large amount of additional PPE that is now required to effectively protect services users and staff from the virus. To date this support is still to be seen by care providers some of whom are actually being expected to use forms of electronic call monitoring to deliver their services and in order to receive payment.

PPE is paramount in social care because when providing support such as assistance with personal care, going to the toilet and assisting people to eat, social distancing is just not possible. Moving and assisting equipment may be in place where people are hoisted out of bed or may receive the vast majority of care in their bed. Keeping 2 meters away from each other and the resident is not going to work in these situations so PPE must be available to keep them safe. Lack of testing for staff has resulted in time off being taken when COVID-19 is suspected but not known for sure.  It also results in staff having to be placed in vulnerable situations themselves, caring for others while not knowing if they are carrying the virus or are effectively protecting their services users due to lack of necessary equipment such as face masks.  For care at home travelling to services has been an additional issue and care staff have been fined for doing so even though they literally had no other choice due to lack of transport in some areas.  All of this contributes to care staff feeling undervalued and underappreciated and that is before they have been turned away from shops and told they are not real key workers.

Once this initial crisis has passed there must be real authentic conversations taking place to ensure that our social care workers are no longer treated as second class citizens. Our lives have changed dramatically and when things will go back to the way they were remains to be seen. We do know that social care will continue to be a huge part of peoples’ lives, caring for others with disabilities, in ill health and in older age must continue to be a priority as must the workforce that provide this care. Giving social care workers and nurses the respect they deserve and the recognition of the work they do will ensure we have a workforce who can remain healthy, both physically and mentally and are rewarded for the work they do with decent pay and terms and conditions.  Surely this is the very least that we can do to thank them and show how much they are valued and appreciated for all that they do.  If not who were you really applauding on a Thursday evening at 8pm?

Caroline Deane

Workforce Policy & Practice Lead